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E Health India 2011 -  Gandhinagar  December 16 th  , 2011
eindia.eletsonline.com Product Snapshot
<ul><li>Profile </li></ul><ul><li>26.2 lac Artisans and Weaver families( 1.04 cr lives)in clusters spread across 29 states...
eindia.eletsonline.com Challenges in Execution
<ul><li>Initial Model  -  De centralized </li></ul><ul><li>Claim intimation by OPD through manual paper claims to local br...
<ul><li>Revised Model -  Centralized </li></ul><ul><li>Claim intimation by OPD through manual paper claims to central loca...
eindia.eletsonline.com The Necessity Of Technology  To build efficiency, optimize recourses and build sustainable long ter...
Technology – Need  <ul><li>Dimensions that drove innovation: </li></ul><ul><ul><li>Increase in enrolled no of beneficiarie...
OPD Claim Application Platform - Rpos Technology Innovation <ul><li>Rpos…….(rural point of service) </li></ul><ul><li>Appl...
Rpos  an innovation towards cashless OPD Technology Innovation <ul><li>Rural POS was further developed to address : </li><...
Rpos Technology Innovation eindia.eletsonline.com
Rpos…… Technology Innovation eindia.eletsonline.com
Technology Innovation Impact  <ul><ul><li>Prevention of data loss. </li></ul></ul><ul><ul><li>Manipulation in the claims i...
Improving the lives of the billions of people at the bottom of the pyramid is a noble endeavor. It can also be a lucrative...
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Health Insurance- Leveraging Technology for Scalable Models- Nagarajan R, Vice President, ICICI Lombard

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Transcript of "Health Insurance- Leveraging Technology for Scalable Models- Nagarajan R, Vice President, ICICI Lombard"

  1. 1. E Health India 2011 - Gandhinagar December 16 th , 2011
  2. 2. eindia.eletsonline.com Product Snapshot
  3. 3. <ul><li>Profile </li></ul><ul><li>26.2 lac Artisans and Weaver families( 1.04 cr lives)in clusters spread across 29 states and 605 cities in India. </li></ul><ul><li>Comprehensive Health coverage. </li></ul><ul><li>Eligibility </li></ul><ul><li>Weaver/Artisan, his/her spouse and two children/dependants/parents. </li></ul><ul><li>Age Group between 0 – 80 Yrs </li></ul><ul><li>Facilities </li></ul><ul><li>Cashless treatment for OPD patients </li></ul><ul><li>Cashless treatment for IPD patients </li></ul><ul><li>Reimbursement of medical expenses (OPD/IPD) </li></ul><ul><li>Facts and product performance </li></ul><ul><li>Cashless health facility network of 1,040 OPD Centers and 2,721 hospitals and clinics </li></ul><ul><li>Utilization of benefit by 91% beneficiaries in first year itself </li></ul><ul><li>65 lac Claims intimated per annum on an average. </li></ul>Product – Features and Coverage eindia.eletsonline.com
  4. 4. eindia.eletsonline.com Challenges in Execution
  5. 5. <ul><li>Initial Model - De centralized </li></ul><ul><li>Claim intimation by OPD through manual paper claims to local branch office. </li></ul><ul><li>Claims forwarded for processing by internal team to central team </li></ul><ul><li>Concerns </li></ul><ul><li>Tons of claim papers received. </li></ul><ul><li>No hygiene in the billing period and late intimation </li></ul><ul><li>Loss of documents in transit. </li></ul><ul><li>Delayed processing </li></ul>Challenges in Execution Paper based claim intimation and processing Late payment and provider Grievance eindia.eletsonline.com
  6. 6. <ul><li>Revised Model - Centralized </li></ul><ul><li>Claim intimation by OPD through manual paper claims to central location </li></ul><ul><li>Submission of claim data in compact disc. </li></ul><ul><li>Concerns </li></ul><ul><li>Tagging of claim document to invoice nearly impossible owing to volume of claims. </li></ul><ul><li>Monitoring document deficiency. </li></ul>Challenges in Execution Central Monitoring - Paper model combined with electronic interface Reconciliation Issues and delays in over all process execution eindia.eletsonline.com Conclusion - The paper based model for huge volume of claims was responsible for process failure
  7. 7. eindia.eletsonline.com The Necessity Of Technology To build efficiency, optimize recourses and build sustainable long term model to handle small ticket high Frequency Claims
  8. 8. Technology – Need <ul><li>Dimensions that drove innovation: </li></ul><ul><ul><li>Increase in enrolled no of beneficiaries over the years. </li></ul></ul><ul><ul><li>Quantum growth In claim nos. </li></ul></ul><ul><ul><li>Massive and challenging service tie-ups with rural providers to provide cashless. </li></ul></ul><ul><ul><li>Changing rural environment </li></ul></ul><ul><ul><li>Computer literacy and availability of internet bandwidth </li></ul></ul>eindia.eletsonline.com
  9. 9. OPD Claim Application Platform - Rpos Technology Innovation <ul><li>Rpos…….(rural point of service) </li></ul><ul><li>Application Structure </li></ul><ul><ul><li>Application built on Oracle .NET platform. </li></ul></ul><ul><ul><li>SQL based server. </li></ul></ul><ul><li>Provisions </li></ul><ul><ul><li>Web based Application </li></ul></ul><ul><ul><li>Simple Dropdown menus </li></ul></ul><ul><ul><li>User authentication modules for exclusivity </li></ul></ul><ul><ul><li>Multiple user based with interface amongst all. </li></ul></ul><ul><ul><li>Automated invoice generation for the specified billing period. </li></ul></ul><ul><ul><li>Served as tool for seamless BSI tracking and recon </li></ul></ul>eindia.eletsonline.com
  10. 10. Rpos an innovation towards cashless OPD Technology Innovation <ul><li>Rural POS was further developed to address : </li></ul><ul><ul><li>Speedy claim intimation and reserve creation </li></ul></ul><ul><ul><li>Adherence to payment TAT </li></ul></ul><ul><ul><li>Regular monitoring of claim process and trends. </li></ul></ul><ul><ul><li>Maintain hygiene in processes and recon with network. </li></ul></ul><ul><ul><li>Real time validations on the inputs during transaction to ensure hygiene in the Information provided for claim </li></ul></ul><ul><ul><li>System was designed to run on offline and online mode </li></ul></ul><ul><li>Following online provisions were made available on the interface between ILGIC and OPD </li></ul><ul><ul><li>Instantaneous claim intimation in a Non Al environment. </li></ul></ul><ul><ul><li>Ready access to Treatment and claim history till date in a scenario where average claim hit for OPD is between 500 to 2000. </li></ul></ul><ul><ul><li>Claim status for the intimated claims . </li></ul></ul>eindia.eletsonline.com
  11. 11. Rpos Technology Innovation eindia.eletsonline.com
  12. 12. Rpos…… Technology Innovation eindia.eletsonline.com
  13. 13. Technology Innovation Impact <ul><ul><li>Prevention of data loss. </li></ul></ul><ul><ul><li>Manipulation in the claims is checked. </li></ul></ul><ul><ul><li>The activity of an Provider can be tracked on real time basis. </li></ul></ul><ul><ul><li>Less paper work </li></ul></ul><ul><ul><li>Manual Intervention is reduced. </li></ul></ul><ul><ul><li>Enables bulk claim processing. </li></ul></ul><ul><ul><li>Cost of backend operations reduced by 67% ……. </li></ul></ul>A controlled and automated environment provides sustenance to scalable projects.
  14. 14. Improving the lives of the billions of people at the bottom of the pyramid is a noble endeavor. It can also be a lucrative one…C.K. Prahalad Thank You eindia.eletsonline.com

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